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                <h1 id="logan">TRUST – COMMITMENT – CARE</h1>
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                        	<h3 class="title-2">Personal Information</h3>
                           
                            <div class="inner">
                            	<h4>Personal Information</h4>
                                <ul class="lst-registry">
                                	<li>
                                    	<label for="name">Name: <span style="color: #fdae00;">*</span></label>
                                        <input type="text" name="name" value="" id="name">
                                        
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                                    <li>
                                    	<label for="brithday">Birthday: <span style="color: #fdae00;">*</span></label>
                                        <select name="brithday" class="form-select" id="brithday">
                                        <option value="">Month</option>
                                        <option value="1">Jan</option>
                                        <option value="2">Feb</option>
                                        <option value="3">Mar</option>
                                        <option value="4">Apr</option>
                                        <option value="5">May</option>
                                        <option value="6">Jun</option>
                                        <option value="7">Jul</option>
                                        <option value="8">Aug</option>
                                        <option value="9">Sep</option>
                                        <option value="10">Oct</option>
                                        <option value="11">Nov</option>
                                        <option value="12" selected="selected">Dec</option>
                                       </select>
                                       
                                       <select name="brithday-1" class="form-select" id="brithday-1"><option value="">Day</option><option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5">5</option><option value="6">6</option><option value="7">7</option><option value="8">8</option><option value="9">9</option><option value="10">10</option><option value="11">11</option><option value="12">12</option><option value="13">13</option><option value="14">14</option><option value="15">15</option><option value="16">16</option><option value="17">17</option><option value="18">18</option><option value="19">19</option><option value="20">20</option><option value="21">21</option><option value="22" selected="selected">22</option><option value="23">23</option><option value="24">24</option><option value="25">25</option><option value="26">26</option><option value="27">27</option><option value="28">28</option><option value="29">29</option><option value="30">30</option><option value="31">31</option></select>
                                       
                                       <select name="brithday-2" class="form-select" id="brithday-2"><option value="">Year</option><option value="1900">1900</option><option value="1901">1901</option><option value="1902">1902</option><option value="1903">1903</option><option value="1904">1904</option><option value="1905">1905</option><option value="1906">1906</option><option value="1907">1907</option><option value="1908">1908</option><option value="1909">1909</option><option value="1910">1910</option><option value="1911">1911</option><option value="1912">1912</option><option value="1913">1913</option><option value="1914">1914</option><option value="1915">1915</option><option value="1916">1916</option><option value="1917">1917</option><option value="1918">1918</option><option value="1919">1919</option><option value="1920">1920</option><option value="1921">1921</option><option value="1922">1922</option><option value="1923">1923</option><option value="1924">1924</option><option value="1925">1925</option><option value="1926">1926</option><option value="1927">1927</option><option value="1928">1928</option><option value="1929">1929</option><option value="1930">1930</option><option value="1931">1931</option><option value="1932">1932</option><option value="1933">1933</option><option value="1934">1934</option><option value="1935">1935</option><option value="1936">1936</option><option value="1937">1937</option><option value="1938">1938</option><option value="1939">1939</option><option value="1940">1940</option><option value="1941">1941</option><option value="1942">1942</option><option value="1943">1943</option><option value="1944">1944</option><option value="1945">1945</option><option value="1946">1946</option><option value="1947">1947</option><option value="1948">1948</option><option value="1949">1949</option><option value="1950">1950</option><option value="1951">1951</option><option value="1952">1952</option><option value="1953">1953</option><option value="1954">1954</option><option value="1955">1955</option><option value="1956">1956</option><option value="1957">1957</option><option value="1958">1958</option><option value="1959">1959</option><option value="1960">1960</option><option value="1961">1961</option><option value="1962">1962</option><option value="1963">1963</option><option value="1964">1964</option><option value="1965">1965</option><option value="1966">1966</option><option value="1967">1967</option><option value="1968">1968</option><option value="1969">1969</option><option value="1970">1970</option><option value="1971">1971</option><option value="1972">1972</option><option value="1973">1973</option><option value="1974">1974</option><option value="1975">1975</option><option value="1976">1976</option><option value="1977">1977</option><option value="1978">1978</option><option value="1979">1979</option><option value="1980">1980</option><option value="1981">1981</option><option value="1982">1982</option><option value="1983">1983</option><option value="1984">1984</option><option value="1985">1985</option><option value="1986">1986</option><option value="1987">1987</option><option value="1988">1988</option><option value="1989">1989</option><option value="1990">1990</option><option value="1991">1991</option><option value="1992">1992</option><option value="1993">1993</option><option value="1994">1994</option><option value="1995">1995</option><option value="1996">1996</option><option value="1997">1997</option><option value="1998">1998</option><option value="1999">1999</option><option value="2000">2000</option><option value="2001">2001</option><option value="2002">2002</option><option value="2003">2003</option><option value="2004">2004</option><option value="2005">2005</option><option value="2006">2006</option><option value="2007">2007</option><option value="2008">2008</option><option value="2009">2009</option><option value="2010">2010</option><option value="2011">2011</option><option value="2012">2012</option><option value="2013" selected="selected">2013</option><option value="2014">2014</option><option value="2015">2015</option><option value="2016">2016</option><option value="2017">2017</option><option value="2018">2018</option><option value="2019">2019</option><option value="2020">2020</option><option value="2021">2021</option><option value="2022">2022</option><option value="2023">2023</option><option value="2024">2024</option><option value="2025">2025</option><option value="2026">2026</option><option value="2027">2027</option><option value="2028">2028</option><option value="2029">2029</option><option value="2030">2030</option><option value="2031">2031</option><option value="2032">2032</option><option value="2033">2033</option><option value="2034">2034</option><option value="2035">2035</option><option value="2036">2036</option><option value="2037">2037</option><option value="2038">2038</option><option value="2039">2039</option><option value="2040">2040</option><option value="2041">2041</option><option value="2042">2042</option><option value="2043">2043</option><option value="2044">2044</option><option value="2045">2045</option><option value="2046">2046</option><option value="2047">2047</option><option value="2048">2048</option><option value="2049">2049</option><option value="2050">2050</option></select>
                                       
                                       
                                     </li>
                                     <li>
                                    	<label for="placebirth">Place of Birth: </label>
                                        <select name="placebirth" class="form-select-1" id="placebirth"><option value="" selected="selected">select...</option><option value="Australia">Australia</option><option value="Belgium">Belgium</option><option value="Brazil">Brazil</option><option value="Brussel">Brussel</option><option value="Bulgaria">Bulgaria</option><option value="Canada">Canada</option><option value="China">China</option><option value="Czech Republic">Czech Republic</option><option value="Denmark">Denmark</option><option value="Egypt">Egypt</option><option value="Finland">Finland</option><option value="France">France</option><option value="Germany">Germany</option><option value="Greece">Greece</option><option value="Hawaii">Hawaii</option><option value="Holland">Holland</option><option value="Hungary">Hungary</option><option value="Iceland">Iceland</option><option value="India">India</option><option value="Ireland">Ireland</option><option value="Italy">Italy</option><option value="Japan">Japan</option><option value="Liechtenstein">Liechtenstein</option><option value="Luxembourg">Luxembourg</option><option value="Malaysia">Malaysia</option><option value="Monaco">Monaco</option><option value="Netherlands">Netherlands</option><option value="Norway">Norway</option><option value="Poland">Poland</option><option value="Portugal">Portugal</option><option value="Riau - Indonesia">Riau - Indonesia</option><option value="Romania">Romania</option><option value="Russia">Russia</option><option value="Slovak Rep">Slovak Rep</option><option value="Spain">Spain</option><option value="Sweden">Sweden</option><option value="Switzerland">Switzerland</option><option value="Tunisia">Tunisia</option><option value="Turkey">Turkey</option><option value="UK">UK</option><option value="Ukraine">Ukraine</option><option value="USA">USA</option><option value="Venezuela">Venezuela</option><option value="Vietnam">Vietnam</option><option value="Yugoslavia">Yugoslavia</option></select>
                                        
                                     </li> 
                                     <li>
                                    	<label for="sex">Sex: <span style="color: #fdae00;">*</span></label>
                                        <select name="sex" class="form-select-1" id="sex"><option value="" selected="selected">select...</option><option value="female">Female</option><option value="male">Male</option></select>
                                        
                                     </li> 
                                     <li>
                                    	<label for="status">Marital Status:</label>
                                        <input type="text" name="status" value="" id="status">
                                        
                                     </li>
                                     
                                     <li>
                                    	<label for="picture">Upload Picture:</label>
                                       <input type="file" name="files[upload_cv]" class="form-file" id="edit-upload-cv" size="37">
                                        
                                     </li> 
                                    
                                </ul>
                            </div>
                            
                            
                            <div class="inner">
                            	<h4>Contact Information</h4>
                                <ul class="lst-registry">
                                	<li>
                                    	<label for="address">Address: <span style="color: #fdae00;">*</span></label>
                                        <input type="text" name="address" value="" id="address">
                                        
                                    </li>
                                    
                                      
                                     <li>
                                    	<label for="country">Country: <span style="color: #fdae00;">*</span></label>
                                        <select name="country" class="form-select-1 required" id="country"><option value="" selected="selected">select...</option><option value="Australia">Australia</option><option value="Belgium">Belgium</option><option value="Brazil">Brazil</option><option value="Brussel">Brussel</option><option value="Bulgaria">Bulgaria</option><option value="Canada">Canada</option><option value="China">China</option><option value="Czech Republic">Czech Republic</option><option value="Denmark">Denmark</option><option value="Egypt">Egypt</option><option value="Finland">Finland</option><option value="France">France</option><option value="Germany">Germany</option><option value="Greece">Greece</option><option value="Hawaii">Hawaii</option><option value="Holland">Holland</option><option value="Hungary">Hungary</option><option value="Iceland">Iceland</option><option value="India">India</option><option value="Ireland">Ireland</option><option value="Italy">Italy</option><option value="Japan">Japan</option><option value="Liechtenstein">Liechtenstein</option><option value="Luxembourg">Luxembourg</option><option value="Malaysia">Malaysia</option><option value="Monaco">Monaco</option><option value="Netherlands">Netherlands</option><option value="Norway">Norway</option><option value="Poland">Poland</option><option value="Portugal">Portugal</option><option value="Riau - Indonesia">Riau - Indonesia</option><option value="Romania">Romania</option><option value="Russia">Russia</option><option value="Slovak Rep">Slovak Rep</option><option value="Spain">Spain</option><option value="Sweden">Sweden</option><option value="Switzerland">Switzerland</option><option value="Tunisia">Tunisia</option><option value="Turkey">Turkey</option><option value="UK">UK</option><option value="Ukraine">Ukraine</option><option value="USA">USA</option><option value="Venezuela">Venezuela</option><option value="Vietnam">Vietnam</option><option value="Yugoslavia">Yugoslavia</option></select>
                                        
                                     </li> 
                                     <li>
                                    	<label for="phone">Home Phone: <span style="color: #fdae00;">*</span>	</label>
                                        <input type="text" name="phone" value="" id="phone">
                                        
                                     </li>
                                     
                                     <li>
                                    	<label for="phone-1">Office Phone:</label>
                                        <input type="text" name="phone-1" value="" id="phone-1">
                                        
                                     </li>
                                     
                                      <li>
                                    	<label for="phone-2">Cell Phone: <span style="color: #fdae00;">*</span>	</label>
                                        <input type="text" name="phone-2" value="" id="phone-2">
                                        
                                     </li>
                                     
                                     <li>
                                    	<label for="emailaddress">Email Address: <span style="color: #fdae00;">*</span>	</label>
                                        <input type="text" name="emailaddress" value="" id="emailaddress">
                                        
                                     </li>	
                                      <li>
                                    	<label for="cv">Upload CV:</label>
                                       <input type="file" name="cv" class="form-file" id="cv" size="37">
                                        <div class="description-1">Only file type *.doc, *.pdf are allowed. Your file size should not exceed 2Mb</div>
                                     </li> 
                                    
                                </ul>
                            </div>
                             <p class="last"><input type="submit" id="" value="Continue" name=""></p> 
                         </form>   
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